<html>
<head>
<link rel="stylesheet" href="css/principal.css" type="text/css" media="all">
<link rel="shortcut icon" href="images/favicon.ico" />
<link rel="stylesheet" href="js/css/ui-lightness/jquery-ui-1.10.1.custom.css" type="text/css" media="all" />
<script type="text/javascript" src="js/jquery-1.9.1.js"></script>
<script type="text/javascript" src="js/jquery-ui-1.10.1.custom.min.js"></script>
<script src="http://ajax.googleapis.com/ajax/libs/jquery/1.6.2/jquery.min.js"></script>
<script src="js/jquery.maskedinput.js" type="text/javascript"></script>
<script type="text/javascript" src="js/jquery-ui-1.10.1.custom.min.js"></script>
<script type="text/javascript" src="js/development-bundle/ui.accordion.jquery.json"></script>
<script type="text/javascript" src="js/development-bundle/ui.tooltip.jquery.json"></script>
<script type="text/javascript" src="js/development-bundle/ui.datepicker.jquery.json"></script>
<link rel="stylesheet" href="js/css/ui-lightness/jquery-ui-1.10.1.custom.css" type="text/css" media="all" />
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
<script type="text/javascript">
jQuery(function($){
	$("#cnpj_cliente").mask("99.999.999/9999-99");
	$("#cep_cliente").mask("99999-999");  
	$("#data").mask("99/99/9999");  
	$("#cpf").mask("999.999.999-99");  
	$("#cnpj").mask("99.999.999/9999-99");
	$( "#accordion" ).accordion();
	$("[type=button]").button();
	$("[type=submit]").button();
	$( document ).tooltip();
	$( "#tabs" ).tabs();
	$( "#datepicker" ).datepicker();
	$( "#datepicker1" ).datepicker();
});
</script>
</head>

<div class="meio">
<table width="100%">
  <tr>
    <td colspan="2">
		Nome Cliente:<input name="txtNome" type="text" id="txtNome" title="Digite nome do cliente" />&nbsp;&nbsp;&nbsp;&nbsp;
        CNPJ:<input name="txtCnpj" type="text" id="txtCnpj" title="Digite o CNPJ do cliente" />&nbsp;&nbsp;&nbsp;&nbsp;
        <input type="submit" name="Submit" value="Pesquisar" title="Pesquisar cliente">
    </td>
  </tr>
  <tr>
	<td colspan="2">
<div id="accordion">
<h3>Dados Gerais</h3>
<div>
<p>
<p>Nome:<input name="nome_cliente" id="nome_cliente" type="text" value="<? echo $campo['nome'] ; ?>" /></p>

<p>Raz�o Social:&nbsp;<input name="razao_social_cliente" id="razao_social_cliente" type="text" value="<? echo $campo['razaosocial']; ?>"></p>

<p>CNPJ:<input name="cnpj_cliente" id="cnpj_cliente" type="text" value"<? echo $campo['cnpj']; ?>"/></p>

<p>Cidade:<input name="cidade_cliente" id="cidade_cliente" type="text" value="<? echo $campo['cidade']; ?>" />Estado:<input name="estado_cliente" id="estado_cliente" type="text" value="<? echo $campo['estado']; ?>">Pa�s:&nbsp;<input name="pais_cliente" id="pais_cliente" type="text" value="<? echo $campo['pais']; ?>"></p>

<p>Endere�o:<input name="endereco_cliente" id="endereco_cliente" type="text" value="<? echo $campo['endereco']; ?>">Bairro:<input name="bairro_cliente" id="bairro_cliente" type="text" value="<? echo $campo['bairro']; ?>">CEP:&nbsp;<input name="cep_cliente" id="cep_cliente" type="text" value="<? echo $campo['cep']; ?>"></p>
</p>
</div>
<h3>Acordos / Descontos</h3>
<div>
<p>Nome contato:</p>
<p>
<p>Tel. Contato:</p>
</p>
</div>
<h3>Contatos</h3>
<div>
<p>

</p>
</div>
<h3>Importante</h3>
<div>
<p>Importante:</p>
<p>
<textarea rows="4" cols="50"></textarea>
</p>
</div>

<h3>Financeiro</h3>
<div>
<h class="box_esquerda">Data Faturamento
<h class="box_direita">Data Vencimento<br /></h>
<h class="box_esquerda"><input type="text" id="datepicker" /></h>
<h class="box_direita_input"><input type="text" id="datepicker1" /></h>
</div>

<h3>Quem Autoriza &nbsp;&nbsp;&nbsp; / &nbsp;&nbsp;&nbsp; Usa Reserve</h3>
<div>
<p>

</p>
<p>
<h class="box_esquerda">Nome dos Autorizadores
<h class="box_direita">Usa Reserve<br /></h>
<h class="box_esquerda">
    <input type="text" id="datepicker" />
    <h class="box_direita_input">
        <input type="checkbox" id="checkbox65" class="css-checkbox med" checked="checked"/>
        <label for="checkbox65" name="checkbox65_lbl" class="css-label med elegant">SIM</label>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
        <input type="checkbox" id="checkbox65" class="css-checkbox med" checked="checked"/>
        <label for="checkbox65" name="checkbox65_lbl" class="css-label med elegant">N�O</label></h><p>
        <input type="text" id="datepicker" /><br />
        <input type="text" id="datepicker" />
     </h>

</p>
</div>

<h3>Hist�rico de Visitas</h3>
<div>
<p>

</p>
<p>
.............
</p>
</div>
</div>
    </td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
  </tr>
</table>
</div>



<h2>Employment Application</h2>
<script type="text/javascript">
function ValidateForm(frm) {
if (frm.First_Name.value == "") {alert('First name is required.');frm.First_Name.focus();return false;}
if (frm.Last_Name.value == "") {alert('Last name is required.');frm.Last_Name.focus();return false;}
if (frm.Email_Address.value == "") {alert('Email address is required.');frm.Email_Address.focus();return false;}
if (frm.Email_Address.value.indexOf("@") < 1 || frm.Email_Address.value.indexOf(".") < 1) {alert('Please enter a valid email address.');frm.Email_Address.focus();return false;}
if (frm.Position.value == "") {alert('Position is required.');frm.Position.focus();return false;}
if (frm.Phone.value == "") {alert('Phone is required.');frm.Phone.focus();return false;}
if (frm.CaptchaCode.value == "") {alert('Enter security code.');frm.CaptchaCode.focus();return false;}
return true; }
function ReloadCaptchaImage(captchaImageId) {
var obj = document.getElementById(captchaImageId);
var src = obj.src;
var date = new Date();
var pos = src.indexOf('&rad=');
if (pos >= 0) { src = src.substr(0, pos); }
obj.src = src + '&rad=' + date.getTime();
return false; }
</script>
<hr />
<form id="ExampleForm" action="http://www.SnapHost.com/captcha/WebFormSubmit.aspx"
onsubmit="return ValidateForm(this);" method="post">
<input id="SnapHostID" name="SnapHostID" type="hidden" value="5J6F6LFPSZY9" />
<table border="0" cellpadding="5" cellspacing="0">
<tr>
<td style="width:50%">
<b>First name *</b><br />
<input name="First_Name" type="text" maxlength="50" style="width:260px" />
</td>
<td style="width:50%">
<b>Last name *</b><br />
<input name="Last_Name" type="text" maxlength="50" style="width:260px" />
</td>
</tr>
<tr>
<td colspan="2">
<b>Email *</b><br />
<input name="Email_Address" type="text" maxlength="100" style="width:535px" />
</td>
</tr>
<tr>
<td colspan="2">
<b>Portfolio website</b><br />
<input name="Portfolio" type="text" maxlength="255" value="http://" style="width:535px" />
</td>
</tr>
<tr>
<td colspan="2">
<b>Position you are applying for *</b><br />
<input name="Position" type="text" maxlength="100" style="width:535px" />
</td>
</tr>
<tr>
<td style="width:50%">
<b>Salary requirements</b><br />
<input name="Salary" type="text" maxlength="50" style="width:260px" />
</td>
<td style="width:50%">
<b>When can you start?</b><br />
<input name="StartDate" type="text" maxlength="50" style="width:260px" />
</td>
</tr>
<tr>
<td style="width:50%">
<b>Phone *</b><br />
<input name="Phone" type="text" maxlength="50" style="width:260px" />
</td>
<td style="width:50%">
<b>Fax</b><br />
<input name="Fax" type="text" maxlength="50" style="width:260px" />
</td>
</tr>
<tr>
<td colspan="2">
<b>Are you willing to relocate?</b><br />
<input name="Relocate" type="radio" value="Yes" checked="checked" /> Yes &nbsp; &nbsp; &nbsp;
<input name="Relocate" type="radio" value="No" /> No &nbsp; &nbsp; &nbsp;
<input name="Relocate" type="radio" value="NotSure" /> Not sure
</td>
</tr>
<tr>
<td colspan="2">
<b>Last company you worked for</b><br />
<input name="Organization" type="text" maxlength="100" style="width:535px" />
</td>
</tr>
<tr>
<td colspan="2">
<b>Reference / Comments / Questions</b><br />
<textarea name="Reference" rows="7" cols="40" style="width:535px"></textarea>
</td>
</tr>
</table>
<br />
<div style="text-align:center;">
<table border="0" cellpadding="0" cellspacing="0" style="text-align:center; width:300px; margin:auto;">
<tr>
<td><i>Enter security code</i></td>
<td>SECURITY CODE</td>
</tr>
<tr>
<td>
<input name="CaptchaCode" type="text" maxlength="6"
style="width:130px; height:28px; font-size:24px; text-align:center;" />
</td>
<td>
<a href="http://www.SnapHost.com"><img id="CaptchaImage"
style="border:1px solid #999999; vertical-align:bottom;" alt="Web Form Security Code" title="Anti-spam web forms"
src="http://www.SnapHost.com/captcha/WebForm.aspx?id=5J6F6LFPSZY9&ImgType=2" /></a>
<br /><a href="#" onclick="return ReloadCaptchaImage('CaptchaImage');"><span style="font-size:12px;">reload image</span></a>
</td>
</tr>
</table>
<br /><br />
<input name="Submit" type="submit" value="Send Application" />
</div>
</form>

</html>